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NPI Code Detail

MEDICARE: MRS. HEATHER ANNE WIELDE KARLS D.C., C.C.S.P.

MEDICARE: MRS. HEATHER ANNE WIELDE KARLS D.C., C.C.S.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111NS0005XSports Physician Chiropractor3386MN
2111N00000XChiropractor3386MN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2350041729OTHERMNRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15C509KAOTHERMNBLUECROSS BLUESHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578577235
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HEATHER ANNE WIELDE KARLS D.C., C.C.S.P.
Provider Business Mailing Address
First Line : 730 CLEVELAND AVE S
Second Line :
City : SAINT PAUL
State : MN
Zip : 55116-1345
Country : US
Telephone Number : 651-699-8610
Fax Number : 651-699-1207
Provider Business Practice Location Address
First Line : 730 CLEVELAND AVE S
Second Line :
City : SAINT PAUL
State : MN
Zip : 55116-1345
Country : US
Telephone Number : 651-699-8610
Fax Number : 651-699-1207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 01/06/2009

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